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CPT 0364T: Behavior Treatment, Outpatient Behavioral Therapy

CPT code 0364T denotes behavior treatment, a clinical service for behavioral interventions that can be provided in outpatient behavioral health settings. This code is important nationally as behavioral health services are increasingly integrated into routine care and subject to evolving coverage and billing practices. Accurate coding for behavior treatment affects access, continuity of care, and billing consistency across payers.

Key payers covered in this analysis include Aetna, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is used in clinical practice, the typical sites of service, and relevant clinical contexts for common diagnoses associated with anorectal and rectal conditions. The publication summarizes related procedural codes for diagnostic and therapeutic endoscopic evaluation, outlines associated clinical scenarios where behavior treatment may be applied, and highlights payer coverage patterns and documentation considerations where available.

This report provides benchmarks, coding context, and policy-relevant information to help billing staff, clinicians, and compliance teams understand where 0364T fits in care pathways and reimbursement workflows. Data not available in the input are noted where applicable.

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Billing Code Overview

CPT code 0364T represents behavior treatment, a clinical service focused on behavioral interventions. The service type is behavioral therapy / behavior treatment, delivered to evaluate and treat behavioral health or behavior-related conditions. The typical site of service for this code is outpatient behavioral health settings, including clinics or offices where behavioral therapy is provided.

Data not available in the input.

National Reimbursement Benchmarks

National commercial rates for CPT 0364T cluster around the mid-$40s, with BUCA’s average commercial rate at $40.7 serving as the national benchmark average. Cigna’s distribution centers near a $44.1 median and a mean of $40.7, indicating its central tendency aligns with the BUCA average while the top rates reach $44.8 and the low end sits at $35.6.

Dispersion measured by the interquartile range (P75 minus P25) is tight: both BUCA and Cigna share an IQR of $9.2 ($44.8 - $35.6). Cigna’s overall spread from minimum to maximum is wider than BUCA’s provided metrics, given Cigna’s explicit min of $35.6 and max of $44.8, while BUCA’s published percentiles show a similar middle spread without min/max values.

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CPT 0364T: Behavior Treatment, Outpatient Behavioral Therapy

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Billing Code Overview

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National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents to an outpatient gastroenterology clinic with intermittent rectal bleeding, anal discomfort, and changes in bowel habit. Prior to the visit, the patient reported visible bright red blood on stool and occasional mucous discharge. The clinician performs a focused history and anorectal physical exam, then determines that behavior-based therapeutic intervention for toileting and bowel-awareness strategies is indicated to address fecal soiling, evacuation dysfunction, or toileting-related behaviors contributing to symptoms.

The clinical workflow includes: initial evaluation by a Gastroenterology Physician or Family Medicine Physician with documentation of bowel symptoms, prior treatments, and relevant diagnoses such as K62.5 or K64.9; informed consent for behavior treatment is obtained; scheduled face-to-face behavior therapy sessions are delivered by a qualified clinician (e.g., physician or allied professional trained in bowel behavior interventions) focusing on bowel retraining, dietary and toileting habit modification, and biofeedback coaching as appropriate; progress is documented after each session with assessment of symptom change and plan for follow-up or escalation to diagnostic procedures (e.g., 46600, 45330, 45378) if organic pathology is suspected or symptoms persist.

Coding Specifications

Below are the most clinically relevant CMS modifier codes applicable to behavior treatment and related anorectal care, with typical use cases.

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service	Use when an E/M visit is performed on the same day as behavior treatment and is clearly documented as separate and significant.
`59`	Distinct procedural service	Use when a separate procedure (e.g., diagnostic anoscopy `46600`) is performed and must be distinguished from the behavior treatment service.
`76`	Repeat procedure or service by same physician/operator	Use when the same behavior treatment procedure is repeated later same day by the same clinician.
`77`	Repeat procedure by another physician	Use when the behavior treatment is repeated same day by a different physician.
`GT`	Services provided via interactive audio and video telecommunication (telemedicine)	Use when behavior therapy is delivered synchronously via telehealth, if payor accepts this modifier.
`GQ`	Via asynchronous telecommunications system	Use when store-and-forward methods are used for parts of the behavior therapy program and payor recognizes this modifier.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications	Alternative telehealth modifier for payer-specific billing when telemedicine is used.
`22`	Increased procedural services	Use when documented work or complexity of the behavior treatment substantially exceeds usual; substantial documentation required.
`52`	Reduced services	Use when a service is partially reduced or not completed as documented (e.g., abbreviated behavior session).
`59`	Distinct procedural service	Use when another distinct, separate service is provided the same day and documentation supports separation.

Taxonomy Code	Specialty	Notes
`207RG0100X`	Gastroenterology Physician	Common treating specialty for anorectal symptoms and coordination of behavior treatment.
`208C00000X`	Colon & Rectal Surgery Physician	Surgical specialty that may provide or refer for behavior treatment as part of conservative management.
`207Q00000X`	Family Medicine Physician	Primary care providers often initiate behavior interventions and coordinate follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.89`	Other specified diseases of anus and rectum	Includes a range of anorectal conditions that may present with symptoms addressed by behavior treatment, such as inflammation or non-specific anorectal disorders.
`K62.5`	Hemorrhage of anus and rectum	Presents with rectal bleeding; behavior treatment may be used adjunctively for bowel habit modification while diagnostic evaluation proceeds.
`D12.8`	Benign neoplasm of rectum	Benign rectal lesions can cause bleeding or discharge; behavior treatment does not treat the lesion but may be part of symptom management and conservative care.
`K64.9`	Hemorrhoids, unspecified	Hemorrhoids commonly cause bleeding, pain, and soiling; behavior modification (toilet habits, bowel regimen) is a first-line conservative therapy.
`R19.5`	Other fecal abnormalities	Includes fecal incontinence or soiling where behavior treatment (bowel retraining) is a primary therapeutic intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46600`	Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Often performed before or after behavior treatment when direct visualization of the anal canal is needed to evaluate bleeding or local lesions.
`46606`	Anoscopy; with dilation (e.g., balloon, guide wire, bougie) (separate procedure)	Performed when anorectal stricture or sphincter-related narrowing is identified; may follow conservative behavior therapy if mechanical obstruction is suspected.
`45330`	Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Used when distal colonic evaluation is indicated in the diagnostic workup for rectal bleeding or mucous discharge noted during behavior treatment.
`45378`	Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)	Used when a full colonic evaluation is indicated for ongoing bleeding or to rule out colorectal pathology if symptoms do not respond to behavior interventions.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Below are the most clinically relevant CMS modifier codes applicable to behavior treatment and related anorectal care, with typical use cases.

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service	Use when an E/M visit is performed on the same day as behavior treatment and is clearly documented as separate and significant.
`59`	Distinct procedural service	Use when a separate procedure (e.g., diagnostic anoscopy `46600`) is performed and must be distinguished from the behavior treatment service.
`76`	Repeat procedure or service by same physician/operator	Use when the same behavior treatment procedure is repeated later same day by the same clinician.
`77`	Repeat procedure by another physician	Use when the behavior treatment is repeated same day by a different physician.
`GT`	Services provided via interactive audio and video telecommunication (telemedicine)	Use when behavior therapy is delivered synchronously via telehealth, if payor accepts this modifier.
`GQ`	Via asynchronous telecommunications system	Use when store-and-forward methods are used for parts of the behavior therapy program and payor recognizes this modifier.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications	Alternative telehealth modifier for payer-specific billing when telemedicine is used.
`22`	Increased procedural services	Use when documented work or complexity of the behavior treatment substantially exceeds usual; substantial documentation required.
`52`	Reduced services	Use when a service is partially reduced or not completed as documented (e.g., abbreviated behavior session).
`59`	Distinct procedural service	Use when another distinct, separate service is provided the same day and documentation supports separation.

Taxonomy Code	Specialty	Notes
`207RG0100X`	Gastroenterology Physician	Common treating specialty for anorectal symptoms and coordination of behavior treatment.
`208C00000X`	Colon & Rectal Surgery Physician	Surgical specialty that may provide or refer for behavior treatment as part of conservative management.
`207Q00000X`	Family Medicine Physician	Primary care providers often initiate behavior interventions and coordinate follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.89`	Other specified diseases of anus and rectum	Includes a range of anorectal conditions that may present with symptoms addressed by behavior treatment, such as inflammation or non-specific anorectal disorders.
`K62.5`	Hemorrhage of anus and rectum	Presents with rectal bleeding; behavior treatment may be used adjunctively for bowel habit modification while diagnostic evaluation proceeds.
`D12.8`	Benign neoplasm of rectum	Benign rectal lesions can cause bleeding or discharge; behavior treatment does not treat the lesion but may be part of symptom management and conservative care.
`K64.9`	Hemorrhoids, unspecified	Hemorrhoids commonly cause bleeding, pain, and soiling; behavior modification (toilet habits, bowel regimen) is a first-line conservative therapy.
`R19.5`	Other fecal abnormalities	Includes fecal incontinence or soiling where behavior treatment (bowel retraining) is a primary therapeutic intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46600`	Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Often performed before or after behavior treatment when direct visualization of the anal canal is needed to evaluate bleeding or local lesions.
`46606`	Anoscopy; with dilation (e.g., balloon, guide wire, bougie) (separate procedure)	Performed when anorectal stricture or sphincter-related narrowing is identified; may follow conservative behavior therapy if mechanical obstruction is suspected.
`45330`	Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Used when distal colonic evaluation is indicated in the diagnostic workup for rectal bleeding or mucous discharge noted during behavior treatment.
`45378`	Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)	Used when a full colonic evaluation is indicated for ongoing bleeding or to rule out colorectal pathology if symptoms do not respond to behavior interventions.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.